Child Dedication Form

Please fill out this form to request a child dedication and a member of the admin team will contact you.

Child's first name*

Child's last name*

Child's Date of Birth*

Month

Day

Year

Parent's Information

Mother's Full Name*

Father's Full Name*

Phone*

Email*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Are both parents Born Again Christians?*

Yes

Still Considering

Are both parents partners of COGM?

Yes

Which of the following best describes the parents martial & living situation?*

Married & Living Together

Never Married & Living Together

Never Married & Not Living Together

Divorced

Separated

Other

Due to the spiritual nature of the Child Dedication Ceremony, it is helpful for the Pastor to understand the martial and living situation of both parents.

Ceremony Participation

Who will participate in the Child Dedication Ceremony? *

Both Parents

Mother Only

Father Only

Please list any others who will be participating in the ceremony

If you need assistance with completing this form please let us know and we will be happy to assist you.

Email: att.cogfi@gmail.com

Phone: 716-215-6410

Visit Us

Niagara Falls location: 1329 Pine Ave, Niagara Falls, NY 14303

Cheektowaga location: 4600 Union Rd, Cheektowaga, NY 14225

cogfi.ministries@gmail.com | Tel: 716-348-7666

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